目的：研究个体化医学营养治疗（MNT）对妊娠期糖尿病患者（GDM）营养代谢的影响。方法将2010年1月至2012年7月在首都医科大学附属北京同仁医院产科确诊为妊娠糖尿病并接受营养科MNT的87例GDM患者作为研究组，同时期未接受营养科MNT的76例GDM患者作为对照组，研究组内又分为血糖达标组40例和血糖不达标组47例，首次营养科就诊时记录孕12周建档、孕24周糖尿病筛查和分娩前各项指标，比较治疗前后空腹血糖、餐后2小时血糖、血清总蛋白、血清白蛋白、血红蛋白、甘油三酯及胆固醇等指标变化。结果①分娩前研究组空腹血糖和餐后2小时血糖均低于对照组，血红蛋白和高密度脂蛋白胆固醇均高于对照组，有显著性差异（ t值分别为0．006、0．039、0．000、0．008，均P＜0．05）；血清总蛋白、血清白蛋白、甘油三酯、总胆固醇、低密度脂蛋白胆固醇也高于对照组，但无无显著性差异（P＞0．05）；②研究组内血糖达标者与不达标者分娩前的血红蛋白、血清总蛋白、血清白蛋白、甘油三酯、总胆固醇、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇7项指标均无显著性差异（P＞0．05）；③分娩前1周与建档时相比，研究组空腹血糖、餐后2h血糖、总蛋白和白蛋白明显下降，血红蛋白、甘油三酯、总胆固醇、低密度脂蛋白明显升高，有显著性差异（t值分别为2．185、1．152、－1．244、2．185、1．976、－1．865、－1．532、－0．567，均P＜0．05）。高密度脂蛋白胆固醇升高，但无显著性差异（P＞0．05）。结论 MNT可使GDM糖代谢有效改善，预防和纠正孕期贫血，但是对脂代谢影响有限。孕期生理变化是导致脂代谢变化的主要原因，以往将脂代谢用于妊娠期医学营养治疗效果的评价可能不妥。%Objective To study the effect of individualized medical nutrition therapy ( MNT ) on nutrition metabolism of patients with gestational diabetes mellitus ( GDM) .Methods A total of 87 cases of GDM were selected as research objects .All these patients received MNT at the Department of Nutrition in Beijing Tongren Hospital Affiliated to Capital Medical University from January 2010 and July 2012. Over the same period , another 76 patients who did not undergo individualized MNT at the Department of Nutrition were chosen in control group.The treatment group was subdivided into two groups , namely the standard group and the substandard group .The standard group included 40 patients whose blood sugar levels met the standard while the substandard group was made up of 47 patients whose blood sugar levels were below the standard .When patients sought medical attention at the Department of Nutrition for the first time , their physical conditions at gestational weeks of 12 weeks were recorded .Besides, screening for diabetes mellitus was performed at their gestational weeks of 24 weeks.In addition, before delivery, various indicators were documented .Moreover, changes in indicators like fasting blood-glucose, blood sugar levels two hours post meal , serum total protein , serum albumin , hemoglobin , triglyceride and cholesterol before and after the treatment were compared .Results The research group had lower levels of fasting blood-glucose and blood sugar 2 hours post meal than those of the control group before delivery .However , the levels of hemoglobin and high-density lipoprotein cholesterol were higher in the research group than the control group .The preceding differences were of significant difference ( t value was 0.006, 0.039, 0.000, and 0.008, respectively, all P<0.05).In addition, the research group had higher levels of serum total protein , serum albumin, triglyceride, total cholesterol , and low-density lipoprotein cholesterol than the control group .However , the differences were not significant ( all P>0.05).No significant difference was identified between the standard subgroup and the substandard subgroup before delivery in the results of 7 indicators, namely the levels of hemoglobin, serum total protein, serum albumin, triglyceride, total cholesterol, low -density lipoprotein cholesterol and high -density lipoprotein cholesterol (all P>0.05).Comparing with the conditions when their files were set up, at the week before delivery , patients in the research group witnessed significant drop in fasting blood-glucose, blood sugar 2 hours post meal, total protein, and albumin and obvious increase in hemoglobin , triglyceride, total cholesterol, and low-density lipoprotein cholesterol.The preceding differences were significant (t value was 2.185, 1.152, -1.244, 2.185, 1.976, -1.865, -1.532, and-0.567, respectively, all P <0.05).Although the level of high -density lipoprotein cholesterol elevated , the difference was not significant (P>0.05).Conclusion MNT can effectively improve the glucose metabolism of GDM patients , prevent, and cure anemia during pregnancy .However , its effect on lipid metabolism is very limited .Physiological changes during pregnancy are the leading causes of lipid metabolic changes .Therefore, the former approach of using lipid metabolism to assess the effects of MNT during gestation period might be wrong .
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